Surgical instrument

ABSTRACT

A surgical instrument is disclosed. The surgical instrument includes an actuation system, a drive system, and a tool head. The drive system is coupled to the actuation system and includes a rotatable shaft which defines a longitudinal axis. The tool head is coupled to the drive system and includes an annular cartridge and a pliable bunchable ring. The annular cartridge includes a plurality of staples. The pliable bunchable ring surrounds the annular cartridge. The surgical instrument is configured to drive the staples through the pliable bunchable ring substantially transverse to the longitudinal axis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 13/181,798, entitledMODULAR SURGICAL TOOL SYSTEMS, filed Jul. 13, 2011, now U.S. PatentApplication Publication No. 2012/0239010, which claims the benefit ofand priority under 35 U.S.C. § 119(e) from U.S. Provisional PatentApplication Ser. No. 61/452,432, filed Mar. 14, 2011, entitled SURGICALSTAPLING INSTRUMENTS, the entire disclosures of which are herebyincorporated by reference herein.

FIELD OF THE INVENTION

The present invention generally relates to surgical devices forperforming a variety of surgical procedures, and more particularly, to asurgical tool system that comprises a single handle assembly that can beemployed with different tool attachments that are capable of performingdifferent surgical procedures and actions.

BACKGROUND

Circular instruments are used to perform a number of surgicalprocedures. Such procedures often require the use of several differentcircular instruments that have a desired diametric size, shaft lengthand shaft geometry. Hospitals require storage space to inventorymultiple product codes to satisfy these procedures.

One type of circular instrument that is often used in open andlaparoscopic approaches is a circular stapling instrument. In general, aconventional circular stapler typically consists of an elongated shaftthat has a proximal actuating mechanism and a distal stapling mechanismmounted to the elongated shaft. Various circular stapling devices aredisclosed, for example, in U.S. Pat. Nos. 5,104,025; 5,205,459;5,285,945; and 5,309,927 which are each herein incorporated by referencein their respective entireties. The distal stapling mechanism commonlyconsists of a fixed stapling cartridge that contains a plurality ofstaples configured in a concentric circular array. A round cutting knifeis concentrically mounted in the cartridge interior for axial traveltherein. Extending axially from the center of the cartridge is a movabletrocar or attachment shaft that is adapted to have a staple anvilremovably coupled thereto. The anvil is configured to form the ends ofthe staples as they are driven into it. The distance between a distalface of the staple cartridge and the staple anvil is commonly controlledby an adjustment mechanism that is mounted to the proximal end of thestapler shaft for controlling the axial movement of the trocar. Tissuethat is clamped between the staple cartridge and the staple anvil issimultaneously stapled and cut when the actuating mechanism is activatedby the surgeon.

Such circular stapling instruments are essential for creatinganastomosis within the body when using open or laparoscopic methods.However, such instruments cannot perform other actions or proceduresthat may also be required to complete a particular operation. Suchactions may comprise, for example, grasping and manipulating tissue,cutting tissue without deploying fasteners, dilating colon tissue,safely managing the removal of the transected specimens from the colon,etc. Thus, different types and sizes of instruments must be kept onhand.

Thus, the need exists for a surgical tool system that includes a singlehandle assembly that can be employed with different tool attachmentsthat are capable of performing different surgical procedures andactions.

There is a further need for a universal port arrangement that can beused to dilate and/or occlude the colon and facilitate the entry andremoval of surgical instruments within the colon;

There is a further need for a universal port arrangement that may beselectively employed to sever colon tissue.

Yet another need exists for a universal port arrangement that canfacilitate the safe removal of transected colon portions.

The foregoing discussion is intended only to illustrate some of theshortcomings present in the field of the invention at the time, andshould not be taken as a disavowal of claim scope.

BRIEF SUMMARY

-   -   A surgical instrument is disclosed comprising an actuation        system, a drive system coupled to the actuation system, and a        tool head coupled to the drive system. The drive system        comprises a rotatable shaft which defines a longitudinal axis        and an outer casing surrounding the rotatable shaft. The tool        head comprises an annular cartridge comprising a plurality of        staples and a pliable bunchable ring surrounding the annular        cartridge. The surgical instrument is configured to drive the        staples through the pliable bunchable ring in a direction which        is transverse to the longitudinal axis. The outer casing is        configured to deform the staples driven through the pliable        bunchable ring.    -   A surgical instrument is disclosed comprising a pliable        bunchable ring and a stapler head surrounded by the pliable        bunchable ring. The stapler head comprises a plurality of radial        openings, a plurality of staples, and an actuatable drive        assembly. The actuatable drive assembly is configured to drive        the staples through the openings and through the pliable        bunchable ring as the actuatable drive assembly is actuated. The        actuatable drive assembly comprises a rotatable driver        configured to rotate within the stapler head.    -   An end effector of a surgical instrument for fastening a lumen        is disclosed. The end effector comprises an annular cartridge        body, an annular row of fasteners removably stored in the        annular cartridge body, an actuatable drive assembly comprising        a rotatable driver configured to rotate within the end effector,        and a cinching member extending around the annular cartridge        body. The fasteners implant the cinching member to the lumen        when the fasteners are ejected from the annular cartridge body.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the various forms of the present invention.

FIG. 1 is an exploded perspective view of one form of a modular surgicalinstrument of an embodiment of the present invention and a surgical toolhead embodiment of the present invention;

FIG. 2 is a cross-sectional view of one form of a modular surgicalinstrument embodiment of the present invention attached to a surgicaltool head embodiment of the present invention;

FIG. 3 is a partial perspective view of one embodiment of an actuationsystem of a modular surgical instrument embodiment of the presentinvention;

FIGS. 3A-3C are side views of a gear plate embodiment and rotary driveshaft embodiment of the present invention;

FIG. 4 is another cross-sectional view of the modular surgicalinstrument embodiment of and surgical tool head of FIG. 2 with an anvil(shown in phantom lines) attached thereto;

FIG. 5 is a cross-sectional view of the shaft assembly and surgical toolhead depicted in FIGS. 2 and 4;

FIG. 5A is another cross-sectional view of the shaft assembly andsurgical tool head depicted in FIG. 5 with an anvil (shown in phantomlines) attached thereto;

FIG. 6 is a partial cross-sectional view of the handle and shaftassembly of the modular surgical instrument of FIGS. 2 and 4;

FIG. 7 is another partial cross-sectional view of the handle and shaftassembly of FIG. 6 and three different surgical tool head embodiments ofthe present invention;

FIG. 8 is a cross-sectional view of one form of a modular surgicalinstrument embodiment of the present invention attached to anothersurgical tool head embodiment of the present invention;

FIG. 9 is a cross-sectional view of the shaft assembly and surgical toolhead depicted in FIG. 8;

FIG. 10 is a partial side view of one rotary drive shaft embodiment ofthe present invention;

FIG. 11 is a partial cross-sectional perspective view of the surgicaltool head depicted in FIGS. 8 and 9;

FIG. 12 is a cross-sectional view of the surgical tool head of FIG. 11;

FIG. 13 is a partial perspective view of a portion of the rotary driveshaft and an adapter cap embodiment of the present invention;

FIG. 14 is an exploded perspective view of a rotary drive shaftembodiment and a gear drive adapter shaft embodiment of the presentinvention;

FIG. 15 is an assembled view of the rotary drive shaft and gear driveadapter shaft embodiment of FIG. 14;

FIG. 16 is a partial cross-sectional view of another surgical tool headembodiment of the present invention with the movable jaws thereof in anopen position;

FIG. 17 is another partial cross-sectional view of the surgical toolhead embodiment of FIG. 16 with the movable jaws thereof in a closedposition;

FIG. 18 is a partial cross-sectional view of another surgical tool headembodiment of the present invention with the movable jaws thereof in anopen position;

FIG. 19 is another partial cross-sectional view of the surgical toolhead embodiment of FIG. 18 with the movable jaws thereof in a closedposition;

FIG. 20 is a partial top view of a rotary adapter employed in thesurgical tool head of FIGS. 18 and 19;

FIG. 21 is a partial cross-sectional view of another surgical tool headembodiment of the present invention with various component portionsthereof omitted for clarity;

FIG. 22 is a partial cross-sectional view of another surgical tool headembodiment of the present invention with various component portionsthereof omitted for clarity;

FIG. 23 is a partial cross-sectional view of a modular surgicalinstrument embodiment wherein the surgical staples have been drivenhorizontally through an elastic ring supported within the colon;

FIG. 24 is another partial cross-sectional view of a modular surgicalinstrument embodiment wherein the surgical staples have been drivenhorizontally through an elastic ring supported on the distal end of ashaft assembly;

FIG. 25 is another partial cross-sectional view illustrating surgicalstaples that have been driven horizontally through an elastic ringsupported within the colon with a metal ring removably inserted into theinterior of the elastic ring to prevent the elastic ring fromcollapsing;

FIG. 26 illustrates a colon portion wherein the elastic rings disclosedin FIGS. 23-25 have been attached to the ends of the colon portion andare in a collapsed state;

FIG. 27 is a partial cross-sectional perspective view of a severedportion of the colon being pulled through a tube inserted through therectum;

FIG. 28 is a partial perspective view of portions of a patient's colonafter the diseased portion has been removed through a port installed inthe rectum;

FIG. 29 is a partial cross-sectional view of a universal port memberembodiment of the present invention;

FIG. 30A is a top cross-sectional view of a first ring stage of theuniversal port member of FIG. 29 taken along line 30A-30A in FIG. 29;

FIG. 30B is another top cross-sectional view of the first ring stage ofFIG. 30A in an expanded orientation;

FIG. 31A is a top cross-sectional view of a second ring stage of theuniversal port member of FIG. 29 taken along line 31A-31A in FIG. 29;

FIG. 31B is another top cross-sectional view of the second ring stage ofFIG. 31A in an expanded orientation;

FIG. 32A is a top cross-sectional view of a third ring stage of theuniversal port member of FIG. 29 taken along line 32A-32A in FIG. 29;

FIG. 32B is another top cross-sectional view of the third ring stage ofFIG. 32A in an expanded orientation;

FIG. 33 is a cross-sectional view of another universal port embodimentof the present invention;

FIG. 33A is a diagrammatical perspective view of the universal portembodiment of FIG. 33;

FIG. 33B is another diagrammatical perspective view of another universalport embodiment of the present invention;

FIG. 34 is a top cross-sectional view of another surgical tool headembodiment of the present invention;

FIG. 35 is a partial cross-sectional elevational view of the surgicaltool head embodiment of FIG. 34;

FIG. 36 is a partial cross-sectional view of another universal portembodiment of the present invention in connection with an installationtool;

FIG. 37 is a top cross-sectional view of the universal port andinstallation tool embodiments of FIG. 36 taken along line 37-37 in FIG.36;

FIG. 38 is a top cross-sectional view of the universal port andinstallation tool embodiments of FIGS. 36 and 37 taken along line 38-38in FIG. 36;

FIG. 39 is a top cross-sectional view of the universal port andinstallation tool embodiments of FIGS. 36-38 with the tissue retainingbarbs in a deployed position;

FIG. 40 is a side cross-sectional view of the universal port andinstallation tool embodiments as depicted in FIG. 39;

FIG. 41A is a cross-sectional view of the universal port of FIGS. 36-40;

FIG. 41B is a cross-sectional view of a universal port in accordancewith at least one alternative embodiment;

FIG. 42 is a partial cross-sectional view of a universal port embodimentof the present invention and insertion tube embodiment of the presentinvention positioned within the rectum;

FIG. 43 illustrates a universal port embodiment of the present inventioninstalled in the rectum and wherein a diseased portion of the colon hasbeen severed from a distal portion of the colon;

FIG. 44 illustrates use of a grasping instrument through a universalport embodiment of the present invention;

FIG. 45 is another view of the universal port and grasping instrumentdepicted in FIG. 44;

FIG. 46 is another view of the universal port of FIGS. 44 and 45 whereinthe grasping instrument is being used to draw the diseased colon portionthrough the universal port;

FIG. 47 illustrates use of another universal port embodiment of thepresent invention within a colon wherein a diseased portion has beendrawn therein and the tissue cutting members of the port have beendeployed to sever the diseased portion from the rectum;

FIG. 48 is another view of a portion of a colon with a universal portembodiment of the present invention installed therein;

FIG. 49 is another view of the colon and universal port of FIG. 47wherein a severed diseased portion has been inserted into a collectionbag that is being drawn through the port with a grasping instrument;

FIG. 50 is a partial perspective view of a retrieval instrument used toretrieve an anvil from the surgical site;

FIG. 51 is a partial cross-sectional view of a universal port embodimentof the present invention and insertion tube embodiment of the presentinvention positioned within the rectum with a retrieval tool embodimentof the present invention inserted therein to introduce an anvil into thesurgical site;

FIG. 52 is another view of the universal port, insertion tube andretrieval tool as depicted in FIG. 51 and wherein a diseased portion ofthe colon is being drawn into the retrieval tool by a graspinginstrument inserted therethrough;

FIG. 53 is a partial cross-sectional view of another universal portembodiment of the present invention;

FIG. 54 is a partial cross-sectional view of another port embodiment ofthe present invention and insertion tube embodiment of the presentinvention positioned within the rectum;

FIG. 55 is a perspective view of a portion of the port of FIG. 54 in acollapsed state;

FIG. 56 is another perspective view of the port of FIGS. 54 and 55 in anexpanded state;

FIG. 57 is another partial cross-sectional view of the port andinsertion tube embodiments of FIG. 54;

FIG. 58 is another partial cross-sectional view of the port andinsertion tube of FIG. 57 inserted into a portion of the colon andillustrating deployment of the tissue retaining barbs into the colon;

FIG. 59 is another partial cross-sectional view of the port andinsertion tube of FIG. 57 deployed in a portion of the rectum andwherein a tissue cutting instrument is cutting a diseased portion of thecolon from the rectum;

FIG. 60 is another view of the port and insertion tube of FIGS. 54-59wherein the insertion tube has been detached from the port;

FIG. 61 is another view of the port of FIGS. 54-59 being draw into acircular stapling head embodiment of the present invention;

FIG. 62 is a partial perspective view of another universal portembodiment of the present invention installed within the colon and beingengaged by a circular stapling head embodiment of the present invention;

FIG. 63 a partial cross-sectional view of the circular stapling head anduniversal port of FIG. 62 wherein the universal port has been drawn intothe circular stapling head;

FIG. 64 is another perspective view of a port and insertion tubeembodiment of the present invention installed with the colon and whereina grasping instrument is used to introduce and insert a flexible portmember embodiment therein;

FIG. 65 is a partial cross-sectional perspective view of a tissuemanipulation device embodiment of the present invention inserted intothe colon and engaging a portion thereof;

FIG. 66 is a cross-sectional view of a portion of the tissuemanipulation device and colon of FIG. 65;

FIG. 67 is a partial perspective view of another tissue manipulationdevice embodiment of the present invention inserted into the colon; and

FIG. 68 is a partial perspective view of another tissue manipulationdevice embodiment of the present invention inserted into the colon.

DETAILED DESCRIPTION

The assignee of the present application also owns the followingapplications which were filed on Jul. 13, 2011, and which are eachherein incorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 13/181,779, entitled MULTIPLE        PART ANVIL ASSEMBLIES FOR CIRCULAR SURGICAL STAPLING DEVICES,        now U.S. Patent Application Publication No. 2012/0234892;    -   U.S. patent application Ser. No. 13/181,801, entitled SPECIMEN        RETRACTION DEVICES AND METHODS, now U.S. Pat. No. 8,632,462;    -   U.S. patent application Ser. No. 13/181,807, entitled MODULAR        OCCLUSION AND TISSUE ACQUISITION MECHANISMS FOR CIRCULAR        STAPLING DEVICES, now U.S. Pat. No. 8,827,903;    -   U.S. patent application Ser. No. 13/181,831, entitled TISSUE        MANIPULATION DEVICES, now U.S. Pat. No. 8,858,590;    -   U.S. patent application Ser. No. 13/181,768, entitled        COLLAPSIBLE ANVIL PLATE ASSEMBLIES FOR CIRCULAR SURGICAL        STAPLING DEVICES, now U.S. Patent Application Publication No.        2012/0234890;    -   U.S. patent application Ser. No. 13/181,786, entitled CIRCULAR        STAPLING DEVICES WITH TISSUE-PUNCTURING ANVIL FEATURES, now U.S.        Patent Application Publication No. 2012/0234898;    -   U.S. patent application Ser. No. 13/181,774, entitled ANVIL        ASSEMBLIES WITH COLLAPSIBLE FRAMES FOR CIRCULAR STAPLERS, now        U.S. Pat. No. 8,978,955;    -   U.S. patent application Ser. No. 13/181,842, entitled RECTAL        MANIPULATION DEVICES, now U.S. Pat. No. 8,734,478;    -   U.S. patent application Ser. No. 13/181,836, entitled SURGICAL        ACCESS DEVICES WITH ANVIL INTRODUCTION AND SPECIMEN RETRIEVAL        STRUCTURES, now U.S. Patent Application Publication No.        2012/0238823; and    -   U.S. patent application Ser. No. 13/181,827, entitled SURGICAL        BOWEL RETRACTOR DEVICES, now U.S. Patent Application Publication        No. 2012/0238824.

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the various embodiments of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” or “an embodiment”, or the like, meansthat a particular feature, structure, or characteristic described inconnection with the embodiment is included in at least one embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one embodiment”, or “in an embodiment”, or the like,in places throughout the specification are not necessarily all referringto the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments. Thus, the particular features, structures, orcharacteristics illustrated or described in connection with oneembodiment may be combined, in whole or in part, with the featuresstructures, or characteristics of one or more other embodiments withoutlimitation. Such modifications and variations are intended to beincluded within the scope of the present invention.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” referring to the portion closest to the clinicianand the term “distal” referring to the portion located away from theclinician. It will be further appreciated that, for convenience andclarity, spatial terms such as “vertical”, “horizontal”, “up”, and“down” may be used herein with respect to the drawings. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and/or absolute.

FIG. 1 illustrates one form of a modular surgical instrument 10 of anembodiment of the present invention. In at least one embodiment, themodular surgical instrument 10 includes a universal actuator handleassembly 20 that is attached to an elongated shaft assembly 60 that isconfigured for operable attachment to a variety of different surgicaltool heads. FIG. 1 illustrates a circular stapling head 310 a, theattachment and operation of which will be discussed in further detailbelow. In the depicted embodiment, the handle assembly 20 operablysupports an actuation system generally designated as 100 which isconfigured to selectively apply various forms of actuation motions tothe particular-type of surgical tool head attached thereto. As thepresent Detailed Description proceeds, those of ordinary skill in theart will appreciate that portions of the various modular surgicalinstruments disclosed herein may be configured to operably interfacewith a robotic control system that can provide the requisite actuationmotions to the instruments.

In various embodiments, the handle assembly 20 includes two handle casesegments 21 that may be interconnected together by suitable fastenerarrangements for ease of assembly. The shaft assembly 60 includes anouter shaft casing 70 that is substantially hollow and may be fabricatedfrom two casing segments 72 that are coupled together to form a hollowconduit. The outer shaft casing 70 has a proximal end 74 that is coupledto the handle assembly 20 and an open distal end 76.

The Rotary Drive System

Various embodiments of the modular surgical instrument 10 include aunique and novel transmission or actuation system that facilitates theselective application of a variety of different axial and rotary motionsto a particular surgical tool head attached thereto. Referring to FIGS.2 and 3, one form of actuation system 100 includes a gear plate 110 thatis pivotally supported in the handle assembly 20 for selective pivotaltravel about a pivot axis PA-PA that is substantially transverse to theinstrument's longitudinal axis LA-LA. The gear plate 110 may bepivotally supported within the handle assembly 20 on a pivot shaft 104that extends between the handle case segments 21. As will be discussedin further detail below, the gear plate 110 is also laterally movable onthe pivot shaft 104 from a first rotary drive position to a second axialdrive position by a first drive selector switch 130 that is slidablysupported between the handle case segments 21. As can be seen in FIG. 3,the first drive selector switch 130 is provided with two downwardlyprotruding clevis arms 132 that are configured to receive a proximal endportion 112 of the gear plate 110 therebetween. The first drive selectorswitch 130 extends through slots 22 in the handle case members 21 andhave down turned end portions 134 to enable the user to slide the firstdrive selector switch 130 laterally back and forth (arrow “A” in FIG. 3)within the handle assembly 20 along a selector axis SA-SA that issubstantially transverse to the longitudinal axis LA-LA. An “actuator”in the form of a firing trigger 140 is attached to, or otherwiseintegrally formed with, the gear plate 110 such that the gear plate 110may be selectively pivoted about the pivot axis PA-PA by squeezing thefiring trigger 140 toward the handle assembly 20. The term “actuator”may also encompass a portion of a robotic system configured to apply therequisite actuation motion to the gear plate 110.

As can be further seen in FIG. 2, the gear plate 110 is configured tooperably interact with a rotary drive shaft 150 that extends through theouter shaft casing 70 of the elongated shaft assembly 60 and isrotatably supported therein. In various embodiments the gear plate 110has a first gear rack 114, a second gear rack 116, and a third gear rack118 formed thereon. See FIGS. 3A-3C. The rotary drive shaft 150 has afirst pinion gear 152 that is adapted for selective meshing engagementwith the first gear rack 114 and a second pinion gear 154 that isadapted for selective meshing engagement with the second gear rack 116and a third pinion gear 156 that is adapted for selective meshingengagement with the third gear rack 118. As will become further apparentas the present Detailed Description proceeds, each gear rack 114, 116,118 defines a discrete amount of rotary travel that may be applied tothe rotary drive shaft 150. For example, the first gear rack 114, whenin meshing engagement with the first pinion gear 152, may facilitate anapplication of a first amount of rotary travel to the rotary drive shaft150 upon application of an actuation motion to the firing trigger 140.For example, the first gear rack 114 may facilitate a first amount ofrotary travel of approximately 0.70″ when the firing trigger 140 ispivoted from a starting position to an ending position. The second gearrack 116, when in meshing engagement with the second pinion gear 154,facilitates a second range of rotary travel to the rotary drive shaft150. For example, the second gear rack 116 may facilitate a secondamount of rotary travel of approximately 1.41″ when the firing trigger140 is pivoted from a starting position to an ending or fully depressedposition. The third gear rack 118, when in meshing engagement with thethird pinion gear 156, facilitates a third amount of rotary travel ofapproximately 2.11″ when the firing trigger 140 is pivoted from astarting position to an ending or fully depressed position. It will beunderstood, however, that other numbers and lengths of gear rack andpinion gear arrangements could conceivably be employed to provide otherranges of rotary motion without departing from the spirit and scope ofthe present invention.

Also in various handle assembly embodiments, a torsion spring 142 isemployed to bias the firing trigger 140 to the unactuated position shownin FIG. 1. Thus, in various embodiments, once the surgeon releases thefiring trigger 140, the spring 142 returns the firing trigger 140 to theunactuated position and, in doing so, applies a reverse rotary motion tothe rotary drive shaft 150. Various forms of known trigger safetyarrangements such as those disclosed in U.S. Pat. No. 7,506,791,entitled SURGICAL STAPLING INSTRUMENT WITH MECHANICAL MECHANISM FORLIMITING MAXIMUM TISSUE COMPRESSION, the disclosure of which is hereinincorporated by reference in its entirety, may also be employed.

The rotary drive shaft 150 further has a proximal end 160 that ismovably supported within the handle assembly for rotary and axial traveltherein. In one embodiment, for example, the proximal end 160 of therotary drive shaft 150 is configured to support a bearing assembly 162thereon that is constrained to move in axial tracks 170 formed in thehandle cases 21. See FIG. 2. The bearing assembly 162 facilitatesrotation of the rotary drive shaft 150 about the longitudinal axis LA-LAwhile also facilitating its axial travel within the handle assembly 20and the outer shaft casing 70 of the shaft assembly 60. As can be seenin FIG. 2, a compression spring 164 serves to axially bias the rotarydrive shaft 150 in the distal direction “DD”.

As can also be seen in FIGS. 2-6, the rotary drive shaft 150 is hollowand has a distal end portion 180 that is configured to operationallymate with various forms of surgical tool heads attached thereto. As willbe discussed in further detail below, the distal end portion 180 has anactuator flange 182 formed thereon that is oriented for engagement by aproximal end of the particular surgical tool head or adapter arrangementcoupled thereto. Thus, when a particular surgical tool head is coupledto the shaft assembly 60, its distal end contacts the actuator flange182 to bias the rotary drive shaft 150 in the proximal direction.

Also in various embodiments, the handle assembly 20 may have a window oropening 25 therein (FIG. 1) that facilitates viewing by the surgeon ofan indicator member 190. In various embodiments, the indicator member190 may comprise a tape member that is flexible enough to axially travelback and forth within the handle assembly 20 and be viewable through thewindow or opening 25. The tape member 190 is attached to the bearingassembly 162 as can be seen in FIGS. 2 and 4 and has indication indiciathereon that corresponds to the gear rack 114, 116, 118 that is engagedwith its corresponding pinion gear 152, 154, 156, respectively. Forexample, the indicator indicia may comprise a picture, drawing, diagram,model identification number, etc. of the particular surgical tool headthat requires the corresponding amount of discrete rotary travel of therotary drive shaft 150 for actuation purposes.

The Axial Drive Systems

The instrument 10 further includes axial drive arrangements forselectively applying axial actuation motions to the various surgicaltool heads attached to the shaft assembly 60. As was discussed above, afirst drive selector switch 130 is configured to engage the proximal endportion 112 of the gear plate 110. Such arrangement permits the firstdrive selector switch 130 to be used to laterally move the gear plate110 on the pivot shaft 104 between a first rotary drive position whereinan application of an actuation motion to the firing trigger 140 resultsin the application of a rotary drive motion to the rotary drive shaft150 and a second axial drive position wherein an application of anactuation motion to the firing trigger 140 results in the application ofan axial drive motion to an axial drive bar 200. More specifically andwith reference to FIGS. 2-4, the axial drive bar 200 is coupled to anaxial drive linkage 210 that is configured to releasably interface withthe gear plate 110. As can be seen in FIG. 3, the gear plate 110 has anengagement lug 120 formed thereon that has a hole 122 that is sized toreceive a first engagement pin 212 that protrudes from the axial drivelinkage 210. The axial drive bar 200 is pinned to a linkage bar 214 by apin 216 that extends through the linkage bar 214 into a slot 218 in oneof the handle cases 21. As can be most particularly seen in FIG. 3, thefirst engagement pin 212 is also attached to the linkage bar 214 andprotrudes therethrough into a second slot 220 in the handle case 21. Acompression spring 222 is supported within the slot 220 to bias the pin212 within the slot 220 to the starting position shown in FIG. 3. Theaxial drive bar 200 has a distal end 201 that is configured to engage acorresponding portion of the particular surgical tool head that has beencoupled to the modular surgical instrument 10 to apply the requisiteamount of axial drive motion thereto.

Thus, to actuate the axial drive bar 200, the surgeon laterally movesthe first drive selection switch 130 in the “L” direction to bring thepin 212 into the hole 122 in the gear plate attached lug 120. Thisaction also moves the gear plate 110 to the axial drive position whereinall of the gear racks 114, 116, 118 are out of meshing engagement withtheir corresponding pinion gears 152, 154, 156 on the rotary drive shaft150 and the gear plate 110 is in driving engagement with the axial drivebar 200. Thereafter, the surgeon may depress the firing trigger 140 todrive the axial drive bar 200 distally within the outer shaft casing 70of the shaft assembly 60. When the surgeon releases the firing trigger140, the springs 222 and 142 bias the gear plate 110, axial drive bar200 and firing trigger 140 back to the starting position.

As will be discussed in further detail below, various of the surgicaltool head embodiments of the present invention require rotary actuationmotions to be applied to various portions of the tool head that areaxially displaced from each other. Such axial displacement can berelatively small and may be accomplished without completely de-meshingone of the pinion gears 152, 154, 156 from its respective rack gear 114,116, 118 so that activation of the firing trigger 140 results in theapplication of rotary motion to the rotary drive shaft 150. In at leastone embodiment, a second axial drive switch 230 is employed. In variousforms, the second axial drive switch 230 comprises a slider switch thatcan be slid between multiple positions which correspond to various axialpositions of the rotary drive shaft 150. The slide switch 230 mayinclude, for example, a clevis-type arrangement that permits the rotarydrive shaft 150 to rotate relative thereto and serves to apply an axialmotion to the rotary drive shaft 150 to move it axially within thehandle assembly 20 and outer casing 70 of the shaft assembly 60. SeeFIG. 1.

Tool Component Acquisition and Operational Adjustment Drive System

Various embodiments of the modular surgical instrument 10 of the presentinvention include a tool acquisition shaft 240 that axially extendsthrough the rotary drive shaft 150 and is independently movable relativethereto. In various embodiments, the proximal end portion 242 of thetool acquisition shaft 240 has a series of helical threads 244 thereonthat is configured to rotatably interface with a closure nut portion 246interfacing with an adjustment knob 248 located on the proximal end ofthe handle assembly 20. Such adjustment knob and closure nutarrangements are known in the art and will not be described in furtherdetail herein. See, e.g., U.S. Pat. No. 7,506,791, the disclosure ofwhich has been herein incorporated by reference. Thus, rotation of theadjustment knob 248 relative to the handle assembly 20 will result inthe axial movement of the tool acquisition shaft 240 within the rotarydrive shaft 150.

Surgical Tool Heads

As is apparent from the foregoing description, various forms of themodular surgical instrument 10 are well-suited for actuating a varietyof different forms of surgical tool heads that may be required, forexample, during a single surgical operation—particularly thosedevices/tool heads that are used to perform different surgicalprocedures or actions within the colon. Such surgical tool heads may beprovided in a kit form wherein the kit includes at least two differentsurgical tool heads for use with a modular surgical instrument 10. Invarious embodiments, each surgical tool head has an outer casing thathas an attachment stem portion that is sized to be received within thedistal end 76 of the outer shaft casing 70 of the shaft assembly 60. Thedistance in which the attachment stem portion extends into the outershaft casing 70 will dictate the axial position of the rotary driveshaft 150 and ultimately which pinion gear 152, 154, 156 is brought intomeshing engagement with its corresponding gear rack 114, 116, 118thereby dictating the amount of rotary drive motion applied to therotary drive shaft 150 upon actuation of the firing trigger 140. Furtherunderstanding of this unique feature may be gleaned from reference toFIG. 7.

FIG. 7 illustrates, in general form, three different forms of surgicaltool heads 310 a, 310 b, 310 c that each require three different amountsof rotary drive motion for actuation thereof. For example, tool head 310a requires ¼ turn of rotary drive motion to actuate. Tool head 310 brequires ½ turn of rotary motion to actuate. Tool head 310 c requiresone full turn of rotary drive motion to actuate. As can also be seen inthat Figure, tool head 310 a has an attachment stem 312 a that isconfigured to be inserted into the shaft assembly 60. Thus, when theattachment stem 312 a is fully seated in the distal end 76 of the outershaft casing 70, the end 311 a of the attachment stem 310 a engages theactuation flange 182 on the rotary drive shaft 150 and biases the rotarydrive shaft 150 in the proximal direction “PD′” to bring the pinion gear156 into meshing alignment with its corresponding gear rack 118.Likewise, tool head 310 b has an attachment stem 312 b that is shorterthan attachment stem 312 a by distance “a” which corresponds to thedistance between the gear rack 118 and 116 as shown. Thus, when theattachment stem 312 b is fully seated in the distal end 76 of the outershaft casing 70, the end 311 b of the attachment stem 312 b engages theactuation flange 182 and biases the rotary drive shaft 150 in theproximal direction “PD” to bring the pinion gear 154 into meshingalignment with its corresponding gear rack 116. Likewise, tool head 310c has an attachment stem 312 c that is shorter than attachment stem 312a by distance “c” which corresponds to the distance between gear racks118 and 114 and is shorter than attachment stem 312 b by distance “b”which corresponds to the distance between the gear racks 116 and 114 asshown. Thus, when the attachment stem 312 c is fully seated in thedistal end 76 of the outer shaft casing 70, the end 311 c of theattachment stem 312 a engages the actuation flange 182 on the rotarydrive shaft 150 and biases the rotary drive shaft 150 in the proximaldirection “PD′” to bring the pinion gear 152 into meshing alignment withgear rack 114.

Various surgical tool head embodiments of the present invention alsoemploy a “bayonet-type” attachment configuration to attach the surgicaltool head to the shaft assembly 60. In particular, as can be seen inFIG. 7, each of the attachment stems 312 a, 312 b, and 312 c areprovided with diametrically-opposed outwardly protruding pins 316. Toattach a surgical tool head to the shaft assembly 60, the user alignsthe pins 316 with corresponding bayonet-type slots 377 provided in thedistal end 76 of the outer shaft casing 70. See FIG. 6. Once the pins316 are aligned with their respective slots 377, the user inserts theattachment stem portion into the distal end 76 of the outer shaft casing70 and, when seated therein, rotates the surgical tool head slightly toseat the pins 316 into their respective bayonet slots 377. In alternateembodiments, the pins may be provided on the outer shaft casing and theslots may be provided in the attachment stems.

Referring to FIGS. 2, 4, 5, and 5A, there is shown a surgical tool head400 that may be effectively used in connection with the variousembodiments of the surgical instruments 10 of the present invention. Inthis embodiment, the surgical tool head 400 comprises a circular staplerhead 410 that only requires axial actuation motion for cutting andstapling tissue. As can be seen in those Figures, the circular staplerhead 410 has an outer casing 412 that has an attachment stem portion 414that is sized to be seated into the distal end 76 of the outer shaftcasing 70. Attachment pins 416 protrude from the attachment stem 414 andare configured to be received within the bayonet slots 377 in the outershaft casing 70. A circular staple driver 420 is movably supportedwithin the outer casing 412. The staple driver 420 operably supports aplurality of surgical staples 422 therein in a known fashion. A tissuecutting member 430 is concentrically supported with the staple driver420.

In use, the circular stapler head 410 must be used in conjunction withan anvil 440 to form the staples therein. FIGS. 2, 4, and 5A illustrate(in broken lines) a conventional circular stapler anvil 440. Those ofordinary skill in the art will appreciate, however, that any of thevarious collapsible anvil arrangements disclosed in the various patentapplications identified above that are presently owned by the assigneeof the subject application and which have been incorporated byreference, as well as other anvil arrangements, may be employed. Thedepicted anvil 440 includes an anvil head 442 that is attached to ananvil stem 444. The anvil head 442 has a staple-forming surface 446formed thereon that is adapted for confronting relationship with thesurgical staples in the staple head 410.

Use of the surgical tool head 400 will now be described. Prior toinstalling the surgical tool head 400 onto the shaft assembly 60 of themodular surgical instrument 10, the user may bias the first driveselector switch 130 to move the gear plate 110 out of driving engagementwith the rotary drive shaft 150 and into driving engagement with theaxial drive bar 200. Thus, when the attachment stem 414 of the surgicaltool head 400 is inserted into the distal end 76 of the outer shaftcasing 70, in at least one embodiment, the rotary drive shaft 150 may bebiased axially in the proximal direction without regard to the meshingalignment between the pinion gears 152, 154, 156 and the gear racks 114,116, 118. In such circumstances, the stem 414 of the tool head 400 cancontact the flange 182 extending from the rotary drive shaft 150 andpush the drive shaft 150 axially against the biasing force applied byspring 164, as described above. In certain other embodiments, the rotarydrive shaft 150 may be biased axially in the proximal direction by theattachment stem 414 without first moving the gear plate 110 out ofdriving engagement with the gears 152, 154, 156. In at least one suchembodiment, the proximal end and/or distal end of each gear 152, 154,156 may each include a beveled and/or radiused surface which canfacilitate the alignment and/or realignment of the gears 152, 154, 156with their respective gear racks 114, 116, 118, in the event that thisis desirable. If the axial motion of the drive bar 200 is desiredwithout the rotation of the rotary drive shaft 150, the gear plate 110can be disengaged from the drive shaft via selector switch 130 asdescribed above. In any event, the attachment stem 414 of the surgicaltool head 400 can be seated in the outer shaft casing 70 and locked inposition using the bayonet-type connection arrangement described above.Furthermore, when the surgical tool head 400 is attached to the shaftassembly 60, the distal end 201 of the axial drive bar can 200 seatinglyengage the circular stapler driver 420. See FIGS. 2, 4, 5, and 5A. Priorto or after securing the tool head 400 to the shaft assembly 60, incertain embodiments, the user can rotate the control knob 248 at theproximal end of the handle assembly 20 to distally advance the distalend 250 of the adjustment shaft 240 and to enable the user to install atrocar shaft extension 260 thereon. In at least one embodiment, thetrocar shaft extension 260 is configured to removably snap onto thedistal end 250 of the adjustment shaft 240.

In use, the anvil 440 is introduced into the portion of colon to be cutand stapled using any suitable techniques including any conventionalsurgical techniques, any of the techniques described in theaforementioned patent applications, or any of the techniques disclosedherein. In order to assemble the anvil 440 to the surgical instrument10, as described above, the user can insert the portion of the modularsurgical instrument 10 supporting the surgical tool head 400 into thecolon through the patient's anus and into the portion of the colon to beresected. The surgeon can then manipulate the modular surgicalinstrument 10 to bring the trocar shaft extension 260 into retainingengagement with the anvil stem 444. Once the anvil stem 444 is attachedto the trocar shaft extension 260, the user then rotates the adjustmentknob 248 to move the anvil head 442 towards the staple head 410 tocapture the tissue to be cut and stapled therebetween. Once the surgeonhas moved the anvil head 442 into its final position, the user thensqueezes the firing trigger 140 which drives the axial drive bar 200distally. As the axial drive bar 200 is driven distally, the circularstaple driver 420 is driven towards the anvil head 442 thereby drivingthe surgical staples 422 supported therein into forming engagement withthe underside 446 of the anvil head 440 and the cutting knife 430through the captured tissue. Once the cutting and stapling action hasbeen completed, the user may release the firing trigger 140 to permitthe springs 222 and 142 to return the axial drive bar 200 and the firingtrigger 140 to the starting position. Thereafter, the surgeon maywithdraw the modular surgical instrument 10 from the patient.

FIGS. 8, 9, 11, and 12 illustrate another surgical tool head 500 thatmay be effectively used in connection with the various embodiments ofthe modular surgical instrument 10 of the present invention. In thisembodiment, the surgical tool head 500 comprises another form ofcircular stapler head 510. This surgical tool head embodiment requiresthe application of a rotary drive motion thereto to cause the surgicaltool head to cut and staple tissue. As can be seen in FIGS. 8, 9, 11,and 12, the circular stapler head 510 has an outer casing 512 that hasan attachment stem portion 514 that is sized to be seated into thedistal end 76 of the outer shaft casing 70. Attachment pins 516 protrudefrom the attachment stem 514 and are configured to be received withinthe bayonet slots 377 in the outer shaft casing 70. A circular stapledriver 520 is movably supported within the outer casing 512. The stapledriver 520 operably supports a plurality of surgical staples 522 thereinon driver 520 or support members 523 in a known fashion. A tissuecutting member 541 is concentrically attached to the staple driver 520.As can also be seen in FIGS. 11 and 12, the staple driver 520 has a stemportion 530 that has at least one and preferably a pair of helical driveslots 532 therein. The drive slots 532 are configured to receivecorresponding drive pins 542 therein that protrude from an adapter cap540. As can be seen in FIG. 10, the distal end 180 of the rotary driveshaft 150 has a splined outer surface 181 or is fitted with fins fornon-rotatably interfacing with the adapter cap 540. Thus, when the userinserts the attachment stem 514 into the distal end 76 of the outershaft casing 70, the adapter cap 540 slides over the distal end portion180 of the rotary drive shaft 150 such that rotation of the rotary driveshaft 150 results in rotation of the adapter cap 540. See FIG. 13.

Use of the surgical tool head 500 will now be described. Prior toinstalling the surgical tool head 500 onto the shaft assembly 60 of themodular surgical instrument 10, the user may bias the first driveselector switch 130 on the handle assembly 20 to move the gear plate 110out of driving engagement with the rotary drive shaft 150. Theattachment stem 514 of the surgical tool head 500 is inserted into thedistal end 76 of the outer shaft casing 70 and is affixed thereto in themanner described above. Thus, when the attachment stem 514 of thesurgical tool head 500 is inserted into the distal end 76 of the outershaft casing 70, in at least one embodiment, the rotary drive shaft 150may be biased axially in the proximal direction without regard to themeshing alignment between the pinion gears 152, 154, 156 and the gearracks 114, 116, 118. In such circumstances, the stem 514 of the toolhead 500 can contact the flange 182 extending from the rotary driveshaft 150 and push the drive shaft 150 axially against the biasing forceapplied by spring 164, as described above. In certain other embodiments,the rotary drive shaft 150 may be biased axially in the proximaldirection by the attachment stem 514 without moving the gear plate 110out of driving engagement with the gears 152, 154, 156. In at least onesuch embodiment, the proximal end and/or distal end of each gear 152,154, 156 may each include a beveled and/or radiused surface which canfacilitate the alignment and/or realignment of the gears 152, 154, 156with their respective gear racks 114, 116, 118, as appropriate, when therotary drive shaft 150 is displaced relative to the gear plate 110. Inthis embodiment, the circular stapling head 510 may require a ½ rotaryturn, for example, to cut and staple tissue. Thus, in this embodiment,the attachment stem 514 is sized to position the rotary drive shaft 150such that the pinion gear 154 is in alignment with gear rack 116. In theevent that the gear plate 110 had been previously displaced by theselector switch 130, the surgeon may move the selector switch 130 tobring the gear rack 116 into meshing engagement with the pinion gear154. Prior to or after securing the surgical tool head 500 to the shaftassembly 60, similar to the above, the user may rotate the control knob248 to distally advance the distal end 250 of the adjustment shaft 240and to enable the user to install a trocar shaft extension 260 thereto.The trocar shaft extension 260 is configured to removably snap onto thedistal end 250 of the adjustment shaft 240.

The anvil 440, for example, is then attached to the trocar shaftextension 260 and is brought into confronting relationship with thestaple driver 520 as described above. Once the surgeon has moved theanvil head 442 into the final position, the user then squeezes thefiring trigger 140 which rotates the rotary drive shaft 150 and theadapter cap 540 thereon. As the adapter cap 540 rotates, the pins 542,by virtue of their engagement with the slots 532 in the staple driver520, drive the staple driver 520 distally. Such axial motion causes thesurgical staples 422 to be driven into forming engagement with theunderside 446 of the anvil head 442 and the cutting knife 541 to bedriven through the captured tissue. Once the cutting and stapling actionhas been completed, the user may release the firing trigger 140 topermit the springs 142, 222 to return the axial drive bar 200 and thefiring trigger 140 to the starting position. Thereafter, the surgeon maywithdraw the modular surgical instrument 10 and surgical tool head 500from the patient.

FIGS. 16 and 17 illustrate another surgical tool head embodiment 600that may be effectively used in connection with various embodiments ofthe modular surgical instruments 10 of the present invention. In thisembodiment, the surgical tool head 600 comprises a grasper head 610.This embodiment requires the application of a rotary drive motion toactuate the two movable jaws 670, 680 thereof. As can be seen in thoseFigures, the grasper head 610 has an outer casing 612 that has anattachment stem portion 614 that is sized to be seated into the distalend 76 of the outer shaft casing 70. Attachment pins 616 protrude fromthe attachment stem 614 and are configured to be received within thebayonet slots 377 in the outer shaft casing 70. The first and secondmovable jaws 670, 680 are pivotally pinned to the distal end 616 of thecasing 612 for pivotal travel about a common pivot axis between an openposition (FIG. 16) and a closed position (FIG. 17). The first movablejaw 670 has a first gear portion 672 and the second movable jaw 680 hasa second gear portion 682.

As can be seen in FIG. 14, the distal end 180 of the rotary drive shaft150 has a plurality of (four) fins 184 protruding therefrom forattachment with a gear drive adapter shaft 650. As can be seen in FIGS.14 and 15, the gear drive adapter shaft 650 has a body portion 652 thathas two attachment arms 654 protruding therefrom. Each attachment arm654 has a hole or dimple 656 therein that is adapted to retaininglyengage a corresponding detent 186 formed on the distal end portion 180of the rotary drive shaft 150. In addition, the distal end of the geardrive adapter shaft 650 has a drive gear 658 formed thereon adapted tomeshingly engage the gear portions 672 and 682 on the first and secondmovable jaws 670, 680 respectively.

Use of the surgical tool head 600 will now be described. Prior toinstalling the surgical tool head 600 onto the shaft assembly 60 of themodular surgical instrument 10, the user may bias the first driveselector switch 130 on the handle assembly 20 to move the gear plate 110to a neutral position out of driving engagement with the rotary driveshaft 150. The attachment stem 614 of the surgical tool head 600 isinserted into the distal end 76 of the outer shaft casing 70 and isaffixed thereto in the manner described above. In this embodiment, tomove the jaws 670, 680 between the open and closed positions, the geardrive adapter shaft 650 may require a ¼ rotary turn, for example. Thus,the attachment stem 614 is sized to position the rotary drive shaft 150such that the pinion gear 154 is in alignment with gear rack 116.Thereafter the surgeon may move the first drive selector switch 130 tobring the gear rack 116 into meshing engagement with the pinion gear154. However, as indicated above, the rotary drive shaft 150 may also bemoved axially relative to the gear plate 110 without first moving thegear plate 110 to the neutral position. Prior to securing the surgicaltool head 600 to the shaft assembly 60, the user rotates the controlknob 248 on the proximal end of the handle assembly 20 to proximallyadvance the distal end 250 of the adjustment shaft 240 to itsproximal-most position. When the attachment stem 614 is inserted intothe distal end 76 of the outer shaft casing 70, the gear drive adaptershaft 650 is coupled to the distal end 180 of the rotary drive shaft 150in the above described manner. The user may then rotate the gear driveadapter shaft 650 to move the jaws 670, 680 to the closed position bysqueezing the firing trigger 140. When the user releases the firingtrigger, a reverse rotary motion will be applied to the gear driveadapter shaft 650 to pivot the jaws 670, 680 to the open position.

FIGS. 18-20 illustrate another surgical tool head embodiment 700 thatmay be effectively used in connection with the various embodiments ofthe modular surgical instruments 10 of the present invention. In thisembodiment, the surgical tool head 700 comprises a grasper head 710.This embodiment requires the application of a rotary drive motion toactuate the two movable jaws 770, 780 thereof. As can be seen in thoseFigures, the grasper head 710 has an outer casing 712 that has anattachment stem portion 714 that is sized to be seated into the distalend 76 of the outer shaft casing 70. Attachment pins 716 protrude fromthe attachment stem 614 and are configured to be received within thebayonet slots 377 in the outer shaft casing 70. The first and secondmovable jaws 770, 780 are pivotally pinned to the distal end 716 of thecasing 712 for pivotal travel about a common pivot axis between an openposition (FIG. 18) and a closed position (FIG. 19). The first movablejaw 770 has a first actuator rod 772 protruding therefrom and the secondmovable jaw 780 has a second actuator rod 782 protruding therefrom.

This embodiment employs a rotary adapter member 790 that has a centralaperture 792 shaped to non-rotatably receive the distal end portion 180of the rotary drive shaft 150 therein. See FIG. 20. When installed asshown in FIGS. 18 and 19, the first actuator rod 772 extends into afirst arcuate actuation slot 794 and the second actuator rod 782 extendsinto a second arcuate actuation slot 796 in the rotary adapter member790. Thus, when the user rotates the rotary drive shaft 150 in theabove-described manners, the rotary adapter 790 is also rotated whichdrives the first and second movable jaws 770, 780 to the closed positionby virtue of the interaction between the first and second actuator rods772, 782 and their respective actuation slots 784, 796, respectively.When the user releases the firing trigger a reverse rotary motion willbe applied to the rotary adapter 790 to pivot the jaws 770, 780 to theopen position.

FIG. 21 illustrates another surgical tool head embodiment 800 that maybe effectively used in connection with the various embodiments of themodular surgical instruments 10 of the present invention. In thisembodiment, the surgical tool head 800 comprises a circular stapler head810 that has an outer casing 812 that supports a circular staplecartridge 820 therein. The anvil has been omitted from the Figure forclarity. However, the reader will understand that, except for thedifferences noted below, the circular stapler head 810 may otherwiseoperate in the same manner as the stapling heads described above. Thecircular staple cartridge 820 movably supports an outer circular array822 of staple drivers 824 and an inner circular array 826 of stapledrivers 827. Each staple driver 824, 827 supports one or more surgicalstaples 828 thereon. This embodiment requires the application of arotary drive motion to a rotary drive assembly 830 that is rotatablysupported within the circular staple cartridge 820 and non-rotatablyattached to the distal end 180 of the rotary drive shaft 150 in theabove-mentioned manners. The rotary drive assembly 830 includes a drivermember 832 that is attached thereto that supports an outer driver wedge834 configured to drivingly engage the drivers 824 and an inner driverwedge 836 configured to drivingly engage the drivers 826 as the rotarydrive assembly 830 is rotated. Once the stapler head 810 has beenattached to the shaft assembly 60 in the above-described manner, theuser may apply rotary motion to the rotary drive shaft 150 and rotarydrive assembly 830. This embodiment requires a full turn of rotarymotion. Thus, the attachment stem 814 of the circular stapler head 810is sized to move the rotary drive shaft 150 such that the pinion gear152 is brought into meshing alignment with the gear rack 114. Rotarymotion is then applied to the rotary drive shaft 150 and rotary driveassembly 830 by depressing the firing trigger 140. As the rotary driveassembly 830 is rotated about the longitudinal axis LA-LA, the outerdrive wedge 834 sequentially contacts the outer drivers 824 tosequentially drive the surgical staples 828 supported thereon axiallyinto forming contact with the anvil (not shown). Likewise, as the rotarydrive assembly 830 is rotated about the longitudinal axis LA-LA, theinner drive wedge 836 sequentially contacts the inner drivers 826 tosequentially drive the surgical staples 828 supported thereon axiallyinto forming engagement with the anvil. FIG. 22 illustrates a surgicaltool head 800′ that comprises a circular stapler head 810′ that issubstantially the same as the circular stapler head 810, except in thatembodiment, the drive wedges 834′, 836′ are integrally formed in therotary drive adapter 830′.

FIG. 23 illustrates surgical staples 828 that have been driven“horizontally” through an elastomeric retainer ring 850. In thiscontext, the term “horizontally” means that the staples are driven indirections that are substantially transverse to the longitudinal axisLA-LA. During at least one surgical technique, the rectal tissue R canbe pulled proximally into the distal end 76 of the outer shaft casing 70and positioned along the inner sidewall thereof. In variouscircumstances, a grasper can be inserted upwardly through the outershaft casing 70 and engaged with the rectal tissue R such that therectal tissue can then be pulled downwardly into the shaft casing 70. Incertain applications, the grasper can include an expandable portion,such as those described herein, for example, which is configured toexpand outwardly and engage the rectal tissue. Once engaged with thetissue, the expandable portion of the grasper can be retracted inwardlyprior to and/or as the expandable portion is being pulled into the outershaft casing 70. Once the rectal tissue R has been suitably positioned,a tool head attached to the surgical instrument 10 can be insertedupwardly through the outer shaft casing 70 and positioned relative tothe rectal tissue. In various embodiments, the tool head can comprise anannular staple cartridge including staple cavities and staple driverswhich can be configured to eject the staples 828 laterally. In at leastone such embodiment, the staples 828 and the staple drivers can behorizontally supported around the circumference of the staple cartridgeand, likewise, the drive wedge(s) of the tool head and/or staplecartridge can be orientated horizontally to drivingly contact the stapledrivers as the drive assembly is rotated.

Further to the above, in various embodiments, the staple cartridge canfurther comprise the elastomeric retainer ring 850 positioned around theouter surface of the staple cartridge wherein, as the staples 828 aredeployed from the staple cartridge, the staples 828 can penetrate theretainer ring 850. In various other embodiments, the ring 850 can bepositioned relative to the rectal tissue R before the tool head of thesurgical instrument is positioned within the outer shaft casing 70. Oncethe tool head and staple cartridge are positioned, though, the staples828 can be driven through the elastomeric retainer ring 850 into thedistal end 76 of the outer shaft casing 70 and formed thereby. In atleast one such embodiment, the distal end portion 76 of the outer shaftcasing 70 may include a hardened anvil insert against which the staplescan be deformed. In certain embodiments, the tool head and/or staplecartridge can comprise one or more drive wedges which are rotated aboutan axis in order to sequentially deploy the staples 828 from the staplecartridge. In certain other embodiments, the tool head and/or staplecartridge can include a cone shaped, or frustoconical, drive wedge whichcan be displaced distally along an axis and cam, or displace, the stapledrivers and the staples 828 simultaneously. In any event, thearrangements described herein can deploy staples within a plane that issubstantially perpendicular or substantially transverse to thelongitudinal tool axis, although other embodiments are envisioned inwhich the staples are deployed within any other suitably-oriented plane,for example.

Further to the above, referring now to FIG. 24, a surgical instrumentconfigured to deploy staples horizontally, laterally, radially, ortraversely relative to the instrument axis may be used with or without aretaining ring. In such embodiments, the staples 828 can be deployeddirectly into the rectal tissue R. Whether or not a retaining ring isutilized, referring now to FIG. 25, a stiffening ring can be utilized toat least temporarily stiffen the staple rectal tissue. In variousembodiments, a rigid ring 852 can be inserted through the outer shaftcasing 70, for example, and fitted within the rectal tissue adjacent tothe staple line in order to hold the overall shape of the rectum. In atleast one embodiment, the rigid ring 852 can be comprised of metal, forexample. Once the rigid ring 852 is no longer needed, a removal tool canbe inserted through the rectum to pull the rigid ring 852 out of thesurgical site.

FIG. 26 depicts a diseased specimen 1508 of the colon 1500 after theelastomeric rings 850 have been stapled into each end of the specimen1508 and the metal rings (if used) have been removed. As can be seentherein, the elastomeric rings 850 serve to bunch up the ends of thediseased specimen 1508 which can reduce the likelihood of depositingdiseased cells from inside of the specimen 1508 as it is being removedthrough the rectum. FIG. 27 illustrates use of a grasper head 900 topull the diseased colon specimen 1508 through a tube 902 inserted intothe rectum. FIG. 28 depicts the colon segments 1502 and 1520 after thespecimen or diseased portion 1508 of the colon has been removed. As canbe seen in that Figure, a conventional anvil 440 has been insertedthrough a distal portion 1520 of the colon 1500. The surgical instrument10 with a horizontal stapling head of the type described above has beeninserted through a port 1501 installed into the patient's anus 1504.

Various embodiments of the modular surgical instrument 10 may be used inconnection with other forms of surgical tool heads that may be employedto uniformly grip and acquire portions of the colon which facilitatesbetter visualization of the portion of the colon to be transected. Suchdevices may also be used to ensure that the transection is madesubstantially perpendicular to the colon. In one embodiment, thesurgical tool head 1000 comprises an expandable universal port 1010. SeeFIGS. 29-32. The universal port 1010 includes an outer shaft portion1012 that has an attachment stem 1014 that is configured to be attachedto the distal end 76 of the outer shaft casing 70 of a modular surgicalinstrument 10 of the various types and constructions described above.See FIG. 29. However, in other embodiments, the outer shaft portion 1012may comprise a portion of a dedicated installation tool. In oneembodiment, a rotary drive shaft extension 1020 is non-rotatablyattached to the distal end portion 180 of the rotary drive shaft 150 inthe various manners described above. The rotary drive shaft extension1020 has a rotary drive gear 1022 attached to its distal end. In thisembodiment, only a small amount of rotation may be required to actuatethe first and second ring stages of the universal port 1010. Thus, theattachment stem portion 1014 may be sized relative to the flange 182 onthe rotary drive shaft 150 such that the pinion gear 156 and gear rack118 may be brought into meshing alignment and remain in meshingalignment as the rotary drive shaft 150 is axially moved in the distaldirection. Such axial movement brings the rotary drive gear 1022 of therotary drive shaft extension 1020 into meshing engagement with each ofthe three ring stages of the universal port 1010 as will be described infurther detail below.

As can be seen in FIG. 29, the universal port 1010 has a first ringstage 1030 that is coupled to a second ring stage 1050 with anattachment feature 1032 that permits relative rotation between the firstring stage 1030 and the second ring stage 1050. The universal port 1010further has a third ring stage 1070 that is coupled to the second ringstage 1050 by an attachment feature 1052 that permits relative rotationof those components. In at least one embodiment, the first ring stage1030 is intended to expand the colon. In the depicted embodiment, thefirst ring stage 1030 includes an expandable first hub assembly 1034that has an elastomeric outer ring 1048 supported thereon. As can beseen in FIGS. 30A and 30B, the first hub assembly 1034 includes a firstcentral gear hub 1036 that has central gear-receiving aperture 1037therein that is configured to receive the drive gear 1022 therein.Attached to the first central gear hub 1036 are a plurality of radiallyextending first spring arms 1038. Each spring arm 1038 has an inner end1039 that is pivotally pinned to the first central gear hub 1036 andextends through a corresponding opening 1013 in the outer shaft portion1012. See FIG. 30B. As can be further seen in FIG. 30B, each spring arm1038 has an outer end 1040 that has a spring member 1042 pivotallypinned thereto. FIG. 30A illustrates the first hub assembly 1034 in acollapsed orientation. Upon application of a rotary motion thereto, thehub assembly 1034 opens to the deployed or expanded orientation depictedin FIG. 30B.

As indicated above, the second ring stage 1050 is attached to the firstring stage 1030 by attachment feature 1032 that permits rotation of thesecond ring stage 1050 relative to the first ring stage 1030. In thedepicted embodiment, the second ring stage 1050 includes an expandablesecond hub assembly 1054 that has a second elastomeric outer ring 1068supported thereon. As can be seen in FIGS. 31A and 31B, the second hubassembly 1054 includes a second central gear hub 1056 that has centralgear-receiving aperture 1057 therein that is configured to receive thedrive gear 1022 therein. Attached to the second central gear hub 1056 isa plurality of radially extending second spring arms 1058. Each secondspring arm 1058 has an inner end 1059 that is pivotally pinned to thesecond central gear hub 1056 and extends through a corresponding opening1015 in the outer shaft portion 1012. See FIG. 31B. As can be furtherseen in FIG. 31B, each spring arm 1058 has an outer end 1060 that has aspring member 1062 pivotally pinned thereto. In addition, each springarm 1058 has a tissue gripping barb 1064 attached thereto that, whendeployed, extend through openings 1069 in the second elastomeric outerring 1068. FIG. 31A illustrates the second hub assembly 1054 in acollapsed orientation. Upon application of a rotary motion thereto, thesecond hub assembly 1054 opens to the deployed or expanded orientationdepicted in FIG. 31B. As the spring arms 1058 move to the expandedorientation, the barbs 1064 are caused to rotate outward.

As indicated above, the third ring stage 1070 is attached to the secondring stage 1050 by attachment feature 1052 that permits rotation of thethird ring stage 1070 relative to the second ring stage 1050. In thedepicted embodiment, the third ring stage 1070 includes an expandablethird hub assembly 1074 that has a third elastomeric outer ring 1088supported thereon. As can be seen in FIGS. 32A and 32B, the third hubassembly 1074 includes a third central gear hub 1076 that has centralgear-receiving aperture 1077 therein that is configured to receive thedrive gear 1022 therein. Attached to the third central gear hub 1076 isa plurality of radially extending third spring arms 1078. Each thirdspring arm 1078 has an inner end 1079 that is pivotally pinned to thesecond central gear hub 1076 and extends through a corresponding opening1017 in the outer shaft portion 1012. See FIG. 32B. As can be furtherseen in FIG. 32B, each spring arm 1078 has an outer end 1080 that has aspring member 1082 pivotally pinned thereto. In addition, each springarm 1078 has a tissue cutting blade 1084 attached thereto that, whendeployed, extend through openings 1089 in the third elastomeric outerring 1088. FIG. 32A illustrates the third hub assembly 1074 in acollapsed orientation. Upon application of a rotary motion thereto, thethird hub assembly 1074 opens to the deployed or expanded orientationdepicted in FIG. 32B. As the spring arms 1078 move to the expandedorientation, the cutting blades 1084 are caused to rotate outwardthrough the openings 1089. The inner end 1079 of each spring arm 1078 isconfigured to lockingly engage the shaft 1012 through the correspondingopening 1017 when in the expanded position, such that upon applicationof a rotary motion thereto (in a counterclockwise direction in FIG.32B), the spring arms 1078 lock in the extended position and do notcollapse when the tissue cutting blades 1084 engage the tissue to besevered.

Operation of the universal port 1010 will now be described. When used inconnection with an embodiment of the surgical instrument 10, the surgeonmay rotate the control knob 248 to distally advance the distal end 250of the adjustment shaft 240 to enable the user to install the rotarydrive shaft extension 1020 thereon. The rotary drive shaft extension1020 is configured to removably snap onto or otherwise removably engagethe distal end 250 of the adjustment shaft 240. After the rotary driveshaft extension 1020 has been attached, the universal port 1010 isattached to the distal end 76 of the outer shaft casing 70. Inparticular, the attachment stem 1014 is seated in the outer shaft casing70 and locked in position using the bayonet-type connection arrangementdescribed above. Prior to inserting the attachment stem 1014 into thedistal end 76 of the outer shaft casing 70, the first drive selectorswitch 130 is moved to disengage the gear plate 110 out of drivingengagement with the rotary drive shaft 150 in the manner describedabove. When the attachment stem 1014 is fully seated within the shaftassembly 60, the rotary drive gear 1022 on the distal end of the rotarydrive shaft extension 1020 is brought into meshing engagement with theopening 1037 in the first hub portion 1036. Once the universal port 1010has been attached to the shaft assembly 60, the first drive selectorswitch 130 is actuated to bring the gear rack 118 into meshingengagement with the pinion gear 156. The universal port 1010 may then beintroduced into the rectum portion 1502 of the colon 1500 through thepatient's anus 1504 to the desired deployment position.

Once the universal port 1010 has been positioned in the desired locationwithin the colon 1500, the surgeon may then expand the first ring stage1030 by squeezing the firing trigger 140. Such action will apply a firstrotary motion to the first hub assembly 1034 causing it to move to theexpanded orientation shown in FIG. 30B to thereby expand the first outerring 1048 into expanding contact with the corresponding inner wallportion of the colon 1500. Once the first ring stage 1030 has beenexpanded, the user may then slide the second axial drive switch 230 tomove the rotary drive shaft 150 distally to bring the drive gear 1022into meshing engagement with the second hub portion 1056 of the secondring stage 1050. Such movement of the rotary drive shaft 150 does notdisengage the pinion gear 156 from the rack gear 118. Once the drivegear 1022 has meshingly engaged the second hub portion 1056, the surgeonmay once again squeeze the firing trigger 140 to impart a second rotarydrive motion to the second hub portion 1056. Such action will apply asecond rotary motion to the second hub assembly 1056 causing it to moveto the expanded orientation shown in FIG. 31B to thereby expand thesecond outer ring 1068 and deploy the barbs 1064 into retainingengagement with the corresponding portion of the colon 1500 to retainthe universal port 1010 in that location. Thereafter, the user may thenslide the second axial drive switch 230 to move the rotary drive shaft150 distally to bring the drive gear 1022 into meshing engagement withthe third hub portion 1076 of the third ring stage 1070. Such movementof the rotary drive shaft 150 does not disengage the pinion gear 156from the rack gear 118. Once the drive gear 1022 has meshingly engagedthe third hub portion 1076, the surgeon may once again squeeze thefiring trigger 140 to impart a third rotary drive motion to the thirdhub portion 1076. Such action will apply a third rotary motion to thethird hub assembly 1076 causing it to move to the expanded orientationshown in FIG. 32B to thereby expand the third outer ring 1088 and deploythe cutting blades 1064 outwardly through the adjacent colon tissue. Asthe third ring stage 1070 is rotated, the cutting blades 1064 sever thecolon at that location. While the above-described operation of theuniversal port 1010 employs the use of the modular surgical instrument10 of various embodiments of the present invention, other embodimentsmay employ a dedicated tool for actuation of the ring stages of theuniversal port in the manners described above without departing from thespirit and scope of various embodiments of the present invention.

FIG. 33 illustrates another universal port embodiment 1110 that onlyemploys two of the ring stages employed by universal port 1010. Forexample, as shown, the embodiment 1110 illustrates use of the first andsecond ring stages 1030, 1050 that operate in the same manner describedabove. However, other embodiments contemplate use of the second andthird ring stages 1050, 1070. In either case, the universal port 1110may be fitted with an occlusion cover to prevent infiltration of tissueinto the portion of the colon in which the universal port 1110 has beeninstalled. For example, in one embodiment, the distal-most ring stage(either 1050 or 1070) has a diaphragm assembly 1120 attached thereto.FIG. 33A illustrates a centrally disposed segmented diaphragm assembly1120. In alternative embodiments, a cover or cap 1121 may be attached tothe distal-most ring stage (either 1050 or 1070) as shown in FIG. 33B.

FIGS. 34 and 35 illustrate yet another universal port embodiment 1200 ofthe present invention that may be used in connection with the surgicalinstrument 10 or with another dedicated instrument capable of applyingaxial actuation motions thereto. In the depicted embodiment, theuniversal port 1200 includes an annular port body or outer casing 1212that has a stem portion 1214 that is configured for removable attachmentto the distal end 76 of the outer shaft casing 70 of an embodiment ofthe surgical instrument 10 in the above-described manner. A deploymentdrive assembly in the form of a rotary drive hub 1220 is rotatablysupported within the outer casing 1212. As can be seen in FIG. 34, therotary drive hub 1220 has an inner bore wall 1222 that has a pair ofhelical slots 1224 therein. The slots 1224 are configured to receive acorresponding actuator pin 1232 that is attached to a drive shaftextension 1230 that is attached to the adjustment shaft 240 employingany of the above-described or similar attachment arrangements. Thus, bydistally advancing the drive shaft extension 1230 by rotating thecontrol knob 248, the rotary drive hub 1220 is rotated about thelongitudinal axis LA-LA by virtue of the interaction between theactuator pins 1232 and helical slots 1224.

As can be seen in FIGS. 34 and 35, a drive gear 1228 is formed aroundthe outer circumference 1126 of the rotary drive hub 1220. The drivegear 1228 is supported to meshingly engage with a gear portion 1242 on aplurality of tissue barb assemblies 1240 that are each rotatablysupported on an annular support ring 1250 as shown. The tissue barbassemblies 1240 have a hook portion 1246 thereon that are adapted tohookingly engage the colon when the universal port 1200 has beendeployed therein. Each hook portion 1246 is configured to protrudethrough a corresponding opening 1213 in the outer casing 1212. Thus,application of the axial drive motion to the adjustment shaft 240ultimately causes the rotary drive hub 1220 to rotate and deploy thehook portions 1246 into the adjacent colon tissue.

FIGS. 36-40 illustrate another universal port embodiment 1400 of thepresent invention that may be used in connection with an embodiment ofthe modular surgical instrument 10 or with a dedicated instrument 1310that has a hollow support shaft 1320 that rotatably supports a rotarydrive shaft assembly 1330 therein. Additionally, FIGS. 36 and 40illustrate use the surgical instrument 1310 with a hollow support orstiffening tube 1340, the purpose of which will be discussed in furtherdetail below. As can be seen in FIGS. 36-40, the hollow support shaft1320 has a plurality of first support arms 1322 protruding therefrom.The rotary drive shaft assembly 1330 has a substantially blunt distalend 1332 and a plurality of second arms 1334 radially extendingtherefrom. The drive shaft assembly 1330 is rotatably supported withinthe support shaft 1320 and is configured to interface with a handle orother source of rotary motion.

In various embodiments, the universal port 1400 has first annular portbody in the form of an outer ring portion 1410 and a second annular portbody in the form of an inner ring portion 1420. In at least one form,the inner and outer ring portions 1410, 1420 are fabricated from a rigidpolymer or other suitable material and are attached together as shown toenable the outer ring 1410 to rotate relative to the inner ring 1420. Aflexible sleeve 1412 is attached to the outer circumference of the firstring stage 1410 and extends beyond the proximal end 1413 thereof asshown and preferably is long enough to protrude out of the patient'sanus. As will become further apparent as the present DetailedDescription proceeds, the sleeve 1412 forms a passageway extending fromthe universal port 1400 which can make repeated insertions of varioussurgical instruments into the rectum easier and simpler and may alsoserve as a wound protector and shield for preventing contact between theextracted specimen and the rectum. Thus, the sleeve 1412 may minimizethe likelihood of “seeding” and makes extraction of the diseasedspecimen easier. In various embodiments, the sleeve 1412 is fabricatedfrom a puncture-resistant weave. In other embodiments, the sleeve has aplastic reducing spiral built therein which could provide the sleevewith “funnel-like” attributes to further the passage of large masses oftissue therethrough.

As can be seen in FIGS. 38 and 39, the inner ring 1420 has a pluralityof barbed sutures 1430 spaced equally around its outer circumference.Each tissue barb 1430 has an end portion 1432 that extends into acorresponding slot 1414 in the outer ring portion 1410. The slots 1414are shaped such that when the universal port 1400 is in the un-deployedor insertion state, the end portion 1432 is substantially completelycontained within the slot 1414 and when the inner ring 1420 is rotatedrelative to the outer ring 1410, the suture barbs 1430 are deployedtherefrom as shown in FIGS. 39 and 40.

As indicated above, the hollow support shaft 1320 has a plurality offirst support arms 1322 radially protruding therefrom and the rotarydrive shaft assembly 1330 has a plurality of second support arms 1334protruding therefrom. As can be seen in FIGS. 40 and 41A-B, the ends ofthe first support arms 1322 are adapted to be received withincorresponding closed end slot formations 1416 formed along the innercircumference of the outer ring 1410. Likewise, the ends of the secondsupport arms 1334 are adapted to be received within corresponding closedend slot formations 1426 formed along the inner circumference of theinner ring 1420.

Use of the universal port 1400 will now be explained. Prior to insertioninto the colon, the universal port 1400 is installed onto the tool 1310.In at least one embodiment, the support shaft 1320 and rotary driveshaft assembly 1330 are axially advanced into the open center area 1402in the universal port 1400 such that the first support arms 1322 areseated in corresponding slot formation 1416 in the outer ring 1410 andthe second support arms 1334 are seated in corresponding slot formations1426 in the inner ring 1420. The hollow stiffening tube 1340 may beinserted over the support shaft 1320 to engage the bottom surface of theouter ring 1413. Once the universal port 1400 has been installed ontothe tool 1310 and the stiffening tube 1340 installed as shown, thesurgeon may then insert the assembly into the rectum portion 1502 of thecolon 1500 through the anus 1504 to bring the universal port 1400 intothe desired location within the rectum portion 1502. See FIG. 42. Oncethe surgeon has determined that the universal port 1400 is located inthe desired position, a rotary actuation motion is applied to the rotarydrive shaft assembly 1330 which rotates the inner ring 1420 relative tothe outer ring 1410 and thereby deploys the suture barbs 1430 into theadjacent colon wall to affix the universal port 1400 thereto.Thereafter, the surgeon may then withdraw the surgical tool 1310 outthrough the stiffening tube 1340 leaving the universal port 1400 andstiffening tube 1340 in position as shown in FIG. 42. As can be seen inFIG. 42, the end of the flexible sleeve 1412 extends around thestiffening tube 1340 and out through the patient's anus 1504. Thesurgeon may then insert other instruments up through the stiffening tube1340 (if retained in place) or through the flexible sleeve 1412 (if thestiffening tube 1340 has been removed) and through the opening 1402 inthe universal port 1400 to gain access to the colon portions beyond.FIGS. 43 and 44 illustrate the universal port 1400 installed in therectum 1502 after the stiffening tube 1340 has been removed. In FIG. 43,the diseased colon portion 1508 has been cut from the distal colonportion 1520. Both the end 1510 of the diseased portion 1508 and the end1522 of the distal colon portion 1520 have been stapled shut. Thoseprocesses may be performed using the various surgical tools, staplingheads and anvil arrangements of various embodiments of the presentinvention or they could have been performed using a separate endocutter(not shown) that was inserted through additional ports or openingsprovided through the abdominal wall.

FIG. 44 illustrates use of a grasping instrument 900 in connection withthe universal port 1400 that has been attached within the rectum 1502 ofthe colon 1500. In this Figure, the diseased portion 1508 of the colon1500 has been cut from the distal portion and wax or other suitablematerial 1512 has been injected over some of the lesions 1511 and a weblike covering material 1514 has been placed over other lesions 1513 toprevent seeding. FIG. 45 illustrates use of the grasping device to grabthe end 1510 of the diseased portion 1508 to pull it back through theuniversal port 1400 as shown in FIG. 46. Thereafter, the diseasedportion 1508 may be severed from the rectum 1502 by a conventionaltissue cutting instrument that is inserted through another port oropening in the abdominal wall. FIG. 47 illustrates, in somewhatdiagrammatic format, a similar arrangement wherein a universal port 1010or 1110 has been used and the diseased portion 1508 has been pulled downtherethrough. In that instance, the surgeon reattaches the surgicalinstrument 10 or installation tool to the universal port to activate thetissue cutting members 1084 thereof to sever the diseased portion 1508from the rectum.

In FIG. 48, a conventional metal clamp 1530 has been installed betweenthe rectum portion 1502 and the diseased portion 1508. In the depictedembodiment, the surgeon is using a cutting instrument 1540 to cut theportion 1503 of the colon 1500 located between the universal port 1400and the clamp 1530. Once the diseased portion 1508 has been separatedfrom the rectum portion 1502, the surgeon may withdraw the severeddiseased portion 1508 through the hole 1402 in the universal port 1400.The sleeve 1412 prevents the diseased portion 1508 from contaminatingthe rectum portion 1502 as it is removed through the anus 1504. Once thediseased portion 1508 of the colon 1500 has been removed, the surgicaltools and tool heads disclosed herein may be inserted through the anus1504 to re-attach the colon portion 1520 to the rectum 1502. In FIG. 49,the diseased portion 1508 has been placed into a pouch 1530 that wasinserted through the universal port 1400.

FIG. 50 illustrates one method of removing an anvil 440 from thesurgical site after use. In this method, a retrieval instrument 1590that has a deployable pouch portion 1592 is inserted through anotheropening or port provided through the abdominal wall. However, those orordinary skill in the art will appreciate that the surgeon may introduceand remove an anvil 440 through the universal port 1400. In particular,it will be further appreciated that the various collapsible anvilarrangements disclosed in the previously incorporated patentapplications are well-suited for this purpose.

Turning to FIGS. 51 and 52, the universal port 1400 and the stiffeningtube 1340 are particularly well-suited for use with a retrieval toolembodiment 1560 of the present invention. In various forms, theretrieval tool 1560 comprises a handle portion 1562 that has a hollowretrieval tube 1564 protruding therefrom that defines a conduit passage1566 extending through the tool to facilitate the passage of toolstherethrough. FIGS. 51 and 52 illustrate the passage of a graspinginstrument 900 therethrough. Various embodiments further include aflexible sleeve 1570 that has a cinchable distal opening 1572 that ispositioned on the distal end 1565 of the retrieval tube 1564. A cinchcord 1574 is attached to around the cinchable opening and extendsthrough a passage 1567 in the retrieval tube 1564 as shown in FIG. 51.FIG. 51 also illustrates use of the retrieval tool 1560 and universalport 1400 for introducing an anvil 440 into the surgical site with agrasping instrument 900. FIG. 52 illustrates the withdrawal of thediseased specimen 1508 into the sleeve 1570 in the retrieval tool 1560.Once the specimen 1508 has been received within the sleeve 1570, thesurgeon may cinch the opening 1572 closed by pulling on the cinch cord1574.

Referring again to FIG. 36, the outer ring portion 1410 and/or the innerring portion 1420 of the universal port arrangement 1400 can becomprised of a rigid material. In at least one embodiment, the ringportion 1410 and/or the ring portion 1420 can be comprised of plastic,for example. FIG. 53 illustrates an alternative universal portarrangement 1400′ that is substantially similar to universal port 1400,except that the inner and/or the outer ring portions 1410, 1420 arefabricated from an elastic material such as, for example, rubber. Insuch an embodiment, a rigid ring 1470 can be positioned within theuniversal port 1400′ to retain the port 1400′ in an expanded orientationduring installation. In at least one embodiment, referring now to FIG.41B, the rigid ring 1470 can be comprised of metal, for example, and cancomprise slots 1476 which are sufficiently aligned with the slots 1426defined in the inner ring 1420 such that the second arms 1334 of thetool 1310 can extend trough the slots 1476 into the slots 1426. In atleast one such embodiment, the rigid ring 1470 can be sized andconfigured such that it is closely received within the inner ringportion 1420 in order to hold the ring portions 1410, 1420 in theirconfigurations when the universal port arrangement 1400′ is beingpositioned within the patient's rectum. Thereafter, the rigid ring 1470can be removed from the port arrangement 1400. In at least one suchembodiment, referring again to FIG. 41B, the rigid ring 1470 cancomprise a slot 1479 which can be configured to be engaged by awithdrawal tool. In certain embodiments, the surgeon may insert agrasping instrument up through the patient's rectum and grasp the rigidring 1470 once the tool 1310 has been disengaged and removed from theport arrangement 1400′ and it is no longer desirable to pass objectsthrough the universal port 1400′. In any event, once the rigid ring 1470has been removed from the universal port 1400′, the flexible rings 1410,1420 can flex inwardly and assume a collapsed position, for example. Seee.g., FIG. 26.

FIGS. 54-60 illustrate another port 1600 embodiment of the presentinvention. As can be most particularly seen in FIGS. 55 and 56, the port1600 has a body portion 1602 that is fabricated from a plurality offlexible slat member 1604. Each slat member 1604 has a distal end 1606that is journaled on a distal ring 1620. Likewise, each slat member 1604has a proximal end 1608 that is journaled on a proximal ring 1622. Theproximal end portions 1608 are configured to releasably engage a distalend 1662 of a stiffening tube 1660. In particular, in at least oneembodiment, a collection of bayonet-type slots 1664 are formed aroundthe outer circumference of the distal end 1662 of the stiffening tube1660. Such bayonet-type arrangement facilitates releasable attachment ofthe port 1600 by aligning the proximal end portions 1608 of the slatmembers 1604 with the slots 1664 and inserting the end portions 1608 andtwisting to seat them in the slots 1664. FIG. 55 illustrates the port1600 in its collapsed state. When in that state, the port 1600 has anouter diameter “OD” and when in an expanded state (FIG. 56), the port1600 has an overall outer diameter “OD1”. The ends of the member have anouter diameter of OD2. In one embodiment, for example, OD may beapproximately 20 mm, OD1 may be approximately 65 mm and OD2 may beapproximately 40 mm. However, other sizes may be employed.

As can be seen in FIGS. 55 and 56, each slat 1604 has a central portion1610 that has a slight radius area formed therein and which has a barbdeployment hole 1612 therethrough. A barbed surgical suture 1630 extendsthrough each barb deployment hole 1612. The sutures 1630 extend throughan actuator conduit 1632 as shown in FIG. 54. An actuator 1640, in theform of a tension cable 1642, is attached to the distal ring 1620. Alsovarious embodiments employ a flexible sleeve 1650 that extends aroundthe port body 1602 and is retained in position by an elastic band orring 1552.

FIG. 54 illustrates use of the port 1600 and the hollow stiffening tube1660. After the port 1600 has been attached to the distal end of thestiffening tube 1660, the sleeve 1550 is deployed to extend over thestiffening tube 1660 and the actuation conduit 1632. The entire devicemay then be inserted through the anus 1504 into the rectum portion 1502of the colon 1500 and oriented in a desired position. As can be seen inFIG. 54, the sleeve 1550 also protrudes out through the anus 1504. Oncethe surgeon has located the port 1600 in the desired position, anactuation motion in the form of tension “T” is applied to the cable 1642to expand the member 1600. As the port 1600 expands, the relativelystiff suture barbs 1630 protrude through the holes 1612 in the slats1604 to engage the colon wall and thereby retain the port 1600 inposition.

FIG. 59 illustrates use of a tissue cutting instrument 1540 to cutthrough the colon portion 1503 that extends between a metal clamp (notshown) and the port 1600. The surgeon may then sever the diseasedportion in the various manners described above and remove them throughthe expanded port 1600 and out through the stiffening tube 1660.Thereafter, the surgeon may detach the stiffening tube 1660 from theport 1600 by applying a twisting motion to disengage the bayonet-typeconnection to enable the stiffening tube to be separated therefrom andpulled out of the anus leaving the sleeve 1650 attached to the port1600. As can be seen in FIG. 60 the port 1600 is permitted to collapseto enable the rectum 1502 to return down to smaller diameter.

FIG. 61 illustrates one method of removing the port 1600 using thesurgical tool 10 or other surgical circular stapler arrangement. In thedepicted embodiment, a retraction adapter shaft 1670 is attached to thedistal end 180 of the rotary drive shaft 150 using the various methodsdescribed above. The retraction adapter shaft 1670 has a plurality ofdistal retraction wedges 1674 radially extending from its distal end1672. In addition, a plurality of proximal retraction wedges 1676radially extend therefrom as shown in FIG. 61. Once the retractionadapter shaft 1670 has been attached as shown, the surgeon may insertthe instrument into the rectum 1502 to the position shown in FIG. 61. Ascan be seen in that Figure, the distal retraction wedges 1674 are inretracting engagement with the distal ring 1620 and the proximalretraction wedges 1676 engage the proximal ring 1622. The surgeon maythen use the slider switch 230 on the handle assembly 20 (FIG. 1) and,if necessary the control knob 248 to axially pull the rotary drive shaft150 and the retraction adapter shaft 1670 proximally. Prior to pullingthe adapter shaft 1670 proximally, the surgeon may attach an anvil ontothe retraction adapter shaft 1670, such that the anvil gets pulled intoposition as the retraction adapter shaft 1670 pulls the port 1600 andattached colon tissue into the central area 401 in the stapling head 400for example. Those or ordinary skill in the art will appreciate thatsuch arrangement serves to draw the colon tissue into position forcutting and stapling. Thereafter, the stapling head 410 may be actuatedas before.

FIGS. 62 and 63 illustrate an alternate port 1700 that has a bodyportion 1702 with a plurality of suture barbs 1704 protruding therefromthat has been attached to the rectum 1502 as shown. The port 1700 alsohas a flexible sleeve 1710 attached thereto. This embodiment alsoemploys a retraction adapter shaft 1720 that has distal retractionwedges 1722 thereon. The surgical instrument 10 is otherwise used asdescribed above to draw the port 1700 into the stapling head 400 asshown. As the port 1700 is drawn into the stapling head 400, the surgeonpulls on the sleeve 1710 such that it disengages from the port 1700 andassumes a position around the stapling head 400. See FIG. 63.

FIG. 64 illustrates use of a flexible port member 1800 in connectionwith a port 1600. As can be see in that Figure, the port member 1800 hasa flexible outer ring 1802 that has a plurality of overlapping spirallyarranged flaps or petal-like members 1806 that serve to close thecentral area 1804 defined by the ring 1802, yet permit the passage ofobjects therethrough. To install the port member 1800 into the port1600, the surgeon may employ a grasping instrument 1820 to insert theport member 1800 into the stiffener shaft 1660 and into the central areaof the expanded port 1600. The port member 1800 may also include aretrieval tab 1810 to enable the surgeon to remove the port member 1800with the grasping instrument 1820.

One of the challenges facing surgeons when performing colorectal surgeryis the difficulty in making the transection in tight and angulatedspaces. Limited visualization, as well as the magnitudes of the forcesthat may generally be required to transect and seal the colon, add tothose challenges. Rather than use a mechanical structure to dilate thehead of a modular circular stapler, the tissue manipulation device 1900of the present invention uses a vacuum to draw the colon down to theshaft diameter. With the colon tissue bound to the vacuum shaft, themanipulation of the shaft can then facilitate relative easy movement ofthe colon for dissection.

As can be seen in FIGS. 65 and 66, the tissue manipulation device 1900,according to at least one embodiment includes a hollow outer shaft 1902that rotatably supports a vacuum shaft 1910 thereon. The hollow outershaft 1902 is substantially rigid and is designed to be inserted intothe rigid shaft portion 1952 of a ring installation instrument 1950 aswill be discussed in further detail below. The vacuum shaft 1910comprises a proximal attachment collar 1912 that is rotatably affixed tothe distal end 1904 of the outer shaft 1902. A seal 1906 is providedbetween the distal end 1904 of the outer shaft 1902 and the proximalattachment collar 1912. The collar 1912 interfaces with a vacuum supplytube 1914 that is attached to a source of vacuum 1916.

In various embodiments, the vacuum shaft 1910 has a screen section 1918therein that is attached to the attachment collar 1912. The screen meshmay comprise stainless steel, titanium, etc. mesh. In at least oneembodiment, the screen mesh may be constructed of two layers of screenat a 45 degree rotation to one another in an effort minimize anylikelihood of clogging with tissue. The distal end of the screen section1918 is attached to a seal ring 1920 that is configured to establish asliding and rotating seal with a central drive shaft member 1930. Asshown in FIGS. 65 and 66, flexible head member 1932 is attached to thedistal end 1931 of the drive shaft 1930. The flexible head 1932 may befabricated from rubber or other flexible material and have a slight biasas shown. Such arrangement enables the surgeon to better manipulateportions of the colon during installation and positioning of theinstrument 1900. However, other head configurations could be use. Thedrive shaft 1930 extends through the outer shaft 1902 and interfaceswith a handle or other arrangement that enables the surgeon to applyrotary and axial motions thereto.

As indicated above, the tissue manipulation device 1900 may be used inconnection with a ring installation instrument 1950. As can be seen inFIGS. 65 and 66, the ring installation instrument 1950 includes a shaft1952 that has a distal end 1954 that is configured to slidably supportan elastic anastomosis ring 1960 thereon. The distal end 1954 of theshaft 1952 further includes a ring deployment member 1956 that isattached to a push rod 1970 that extends through the wall of shaft 1952.

The tissue manipulation device 1900 may be used as follows. The surgeonfirst inserts the ring installation instrument 1950 into the rectumthrough the patient's anus. Thereafter the tissue manipulationinstrument 1900 is inserted through the shaft 1952 and into the colon.The surgeon may then apply an axial motion to the drive shaft 1930 topush a portion of the drive shaft 1930 out of the screened section 1918to manipulate the colon into a desirable position. The vacuum shaft 1910is also advanced distally out of the shaft 1952 to enable the targettissue “TT” to be retrieved. Once the screen section 1918 is positionedadjacent to the target tissue “TT”, the surgeon may then apply thevacuum thereto to draw the target tissue “TT” onto the screen section1918. Thereafter the vacuum shaft 1910 is drawn back into the outershaft 1902 and the shaft 1952 of the ring installation instrument 1950.Such action causes the target tissue “TT” to fold over between thescreen section 1918 and the inner wall of the shaft 1952 as shown. Oncethe target tissue “TT” is positioned between the screen section 1918 theshaft 1952, the surgeon may then apply a pushing motion to the push rod1970 to axially advance the ring deployment member in the distaldirection to push the anastomosis ring 1960 off of the distal end of theshaft 1952 as shown in FIG. 66.

FIG. 67 illustrates another vacuum shaft embodiment 2000 of the presentinvention. In at least one form, the vacuum shaft 2000 has a centralshaft portion 2010 that has three screen sections 2020 that areinterconnected by flexible joints 2022. The distal end of the shaftportion 2010 has a flexible head portion 2024. An outer sleeve 2030 maybe employed to facilitate ease of insertion and when the shaft 2000 hasbeen properly located the user may withdraw the sleeve 2030 from thedevice exposing the screen sections 2020. The screen sectionscommunicate with a source of vacuum as was described above to enable theportions of the colon 1500 to be drawn into engagement therewith tofacilitate better manipulation of the colon 1500.

FIG. 68 illustrates a vacuum shaft embodiment 2000′ that employsspirally arranged screen sections 2020′ that communicate with a sourceof vacuum. As the tissue is drawn into contact with the screen sections2020′ the air in the colon is permitted to exit out the vacuum shaft2000′.

The various embodiments of the present invention represent a vastimprovement over prior surgical methods and devices used to performcolorectal surgery. While several embodiments of the invention have beendescribed, it should be apparent, however, that various modifications,alterations and adaptations to those embodiments may occur to personsskilled in the art with the attainment of some or all of the advantagesof the invention. For example, according to various embodiments, asingle component may be replaced by multiple components, and multiplecomponents may be replaced by a single component, to perform a givenfunction or functions. This application is therefore intended to coverall such modifications, alterations and adaptations without departingfrom the scope and spirit of the disclosed invention as defined by theappended claims.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

The invention which is intended to be protected is not to be construedas limited to the particular embodiments disclosed. The embodiments aretherefore to be regarded as illustrative rather than restrictive.Variations and changes may be made by others without departing from thespirit of the present invention. Accordingly, it is expressly intendedthat all such equivalents, variations and changes which fall within thespirit and scope of the present invention as defined in the claims beembraced thereby.

What is claimed is:
 1. A surgical instrument, comprising: an actuationsystem; a drive system coupled to the actuation system, wherein thedrive system comprises: a rotatable shaft which defines a longitudinalaxis; and an outer casing surrounding the rotatable shaft; and a toolhead coupled to the drive system, wherein the tool head comprises: anannular cartridge comprising a plurality of staples; and a pliablebunchable ring surrounding the annular cartridge, wherein the surgicalinstrument is configured to drive the staples through the pliablebunchable ring in a direction which is transverse to the longitudinalaxis, and wherein the outer casing is configured to deform the staplesdriven through the pliable bunchable ring.
 2. The surgical instrument ofclaim 1, wherein the actuation system comprises a movable gear platewhich defines a rack.
 3. The surgical instrument of claim 2, wherein thedrive system further comprises a pinion gear coupled to the rotatableshaft, wherein the pinion gear is configured to meshingly engage withthe rack.
 4. The surgical instrument of claim 2, wherein the actuationsystem further comprises an actuator coupled to the movable gear plate.5. The surgical instrument of claim 4, wherein the actuator is atrigger.
 6. The surgical instrument of claim 1, wherein the pliablebunchable ring comprises an elastomeric material.
 7. The surgicalinstrument of claim 1, wherein the tool head further comprises arotatable drive assembly coupled to the rotatable shaft, wherein therotatable drive assembly is configured to drive the staples through thepliable bunchable ring substantially transverse to the longitudinal axisas the rotatable shaft is rotated.
 8. The surgical instrument of claim7, wherein the rotatable drive assembly is non-rotatably coupled to therotatable shaft.
 9. The surgical instrument of claim 7, wherein therotatable drive assembly comprises a staple drive member configured todrive the staples from the annular cartridge as the rotatable shaft isrotated.
 10. A surgical instrument, comprising: a pliable bunchablering; and a stapler head surrounded by the pliable bunchable ring,wherein the stapler head comprises: a plurality of radial openings; aplurality of staples; and an actuatable drive assembly configured todrive the staples through the openings and through the pliable bunchablering as the actuatable drive assembly is actuated, wherein theactuatable drive assembly comprises a rotatable driver configured torotate within the stapler head.
 11. The surgical instrument of claim 10,wherein the pliable bunchable ring is comprised of an elastomericmaterial.
 12. The surgical instrument of claim 10, wherein the pliablebunchable ring is removably stored around the stapler head in astretched condition.
 13. The surgical instrument of claim 10, whereinthe pliable bunchable ring is aligned with the radial openings.
 14. Anend effector of a surgical instrument for fastening a lumen, the endeffector comprising: an annular cartridge body; an annular row offasteners removably stored in the annular cartridge body; an actuatabledrive assembly comprising a rotatable driver configured to rotate withinthe end effector; and a cinching member extending around the annularcartridge body, wherein the fasteners implant the cinching member to thelumen when the fasteners are ejected from the annular cartridge body.15. The end effector of claim 14, further comprising an anvil configuredto deform the fasteners.
 16. The end effector of claim 14, wherein thecinching member is aligned with the annular row of fasteners.
 17. Theend effector of claim 14, wherein the cinching member is removablystored around the annular cartridge body in a stretched state.
 18. Theend effector of claim 17, wherein the cinching member is comprised of anelastomeric material.